Dental Medical Billing: Documents and Forms

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Dental Medical Billing: Documents and Forms For Your Dental Practice

When filed appropriately, medical claims can be submitted directly by dentists providing oral appliances for sleep apnea. This courtesy to your patients expands their access to COAT (Continuous Open Airway Therapy)® in the convenience of your own practice. The key for dentists is to understand how and which dental medical billing documents or forms must be completed to file for medical benefit reimbursement.

Obtain and Complete the Proper Documentation Sequence

To qualify for benefits, the medical claim must be accompanied by the correct type of dental and medical history forms. But it does not stop there. The documentation should be submitted in the correct sequence in order to avoid having the claim rejected altogether.

Dental and Medical History Forms to Keep on File

A dentist must show that the patient has had a physician-diagnosed sleep study within the past three years, indicating that medical treatment is necessary of their sleeping disorder. Remember, it’s possible to arrange for such a study to be performed with a take-home kit (as long as it is interpreted by a licensed physician.)  

Secondary data must also indicate that the patient has used a CPAP machine for a minimum of 30 days. On top of that, it must be determined that the patient is “CPAP Intolerant” and has an Epworth Sleepiness Scale reading greater than 10. The affidavit for intolerance (or “noncompliance”) is completed by the patient. No extra physician documentation is needed.

As you work with the partnering physician, your dental/medical history form must also outline two or more chronic conditions (comorbidities) that are impacting the patient’s health. Neither of these can include symptoms of TMJ/D or snoring.

Be sure to clarify the use of the type of oral appliance (OA) being used, and that it is a category “E0486” custom OA (if Medicare patient). The final impression for the OA may need to be dated after you receive the actual E0486 authorization. If your patient is on an HMO plan, you will also need a written medical referral from their PCP.

Additional Financial Forms Necessary

Financial policies are a must, especially for non-traditional sleep medicine services, like COAT (Continuous Open Airway Therapy)®. The signed agreement will outline the patient’s consent for treatment and financial responsibility, along with your attempts to bill insurance and an outline of the estimated costs involved. Being that the medical insurance may likely mail reimbursement checks directly to the patient, it is vital to note that the patient will sign over any checks received.

Guidance on Dental Medical Billing

Dentists and their staff who are looking to provide oral appliances for sleep apnea can access more information on the dental medical billing process by becoming a member of SomAdvantage. SomAdvantage offers members direct access to the Medical Billing Series which includes on demand and live webinars covering the proper documentation practices, medical codes, and descriptors needed to properly file medical claims. SomAdvantage also includes sleep screening tools, marketing resources and more. Click here to access free membership to SomAdvantage today.

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